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“Yes, I'm the practice manager, but also responsible for marketing, graphic design, administrative support, reception, business acquisition, and sales. My head is exploding.”
This was a comment shared by an overworked practice manager during a webinar we recently hosted with our friends at Freedom Practice Coaching. We thought it just captured the plight of the exhausted cash-pay practice manager/owner so perfectly.
The webinar was titled Scaling Teams and Creating a Predictable Future, led by Freedom Practice Coaching’s COO Seth Conger and Dr. Trevor Botts, their VP of Sales. And wow, we’re not sure it’s possible to fit more actionable advice and insights into a 1-hour webinar. They outlined exactly why most practices struggle to scale their teams, and what can be done to break down the most common barriers.
For those who weren’t fortunate enough to take part in the webinar, we still want you to have this knowledge.
This blog will show you how to scale your staff, the Freedom Practice Coaching way. At the end, we will give you an exercise that shows you exactly how to scale your staff based on their proven methods, but don’t simply skip ahead to that section. It won’t make much sense without some vital background info, and the information in the other sections can literally save you hundreds of thousands of dollars!
Before you can remove the barriers that are keeping you from scaling your team, you need to identify (truthfully!) which stage your business is at right now.
According to Freedom Practice Coaching, your practice will fall into 1 of 3 categories:
If your practice is in this stage, you are:
If the “I’m doing everything and my head is exploding” sentiment resonates with you, you’re probably in this stage. And you’re far from alone.
“I think we've estimated that almost 85% of functional and integrative medicine practices are still in the Foundations space,” said Conger.
What’s interesting is this first level is not necessarily defined by the age of your business or the amount of revenue you bring in. According to Botts, most integrative and functional medicine practices never leave this Foundations stage.
“I've worked with and coached multimillion-dollar practices. When we go in and we actually diagnose the needs of the business, their needs are foundational, meaning that these are problems that were never addressed in their infancy and they've just simply grown with them.”
He added, “And now even though they're a multimillion-dollar practice, they're still struggling with all these same challenges.”
Your business can be profitable. It can be well-established with a 20-year track record. However, there is still a ceiling on how much you can scale because of organizational back-office problems you didn’t fix in Year 1.
If your practice is in this stage, you are:
These practices are built by their back-of-the-house operations team, their standard operating procedures, and technology in an intentional way during the previous stage. Now they’re reaping the benefits.
“You’re no longer wondering where the next new patient is going to come from. You have a recurring revenue system in place… And now you're fueled by people and systems, not just by talent and passion. You're not just trading your time for money anymore,” said Conger.
“You're choosing what to do and how to allocate your time for the highest dollar-per-hour rate critical area. Here you're really deciding, do I want to scale my business and take on more patients? And that could mean additional team members, it could be additional locations.”
If your practice is in this stage, you are:
One of the best parts of this stage is that your practice can grow without your personal involvement.
“Your team is actually pushing things forward now, and it's not just all on your shoulders. Your job is now to set the vision and the strategy. Not to necessarily do the work,” said Conger.
Botts added that a Legacy Stage business also has a high-level understanding of things like each patient’s Acquisition Cost (AC) and Lifetime Value (LTV).
“If you're currently sitting in a position where you're like, ‘Oh gosh, I need more patients,’ you are not a legacy business,” said Botts.
“A legacy business can choose to turn up their marketing at any moment and immediately increase their revenue, as long as they know that they've got the back office systems and the team in place to support that level of growth. So they're not worrying about marketing and sales anymore.”
Why did we go through all of that? Because one of the most important keys to hiring is knowing why you may not be set up to hire right now. Because, as we said, 85% of cash-pay practices fall into the Foundations category and are not set up to scale their staff, their business, or their time.
The reactive fashion in which they handle most things will lead to any one of the most common (and most damaging) hiring mistakes:
When most of your business operations are done reactively, your hiring will be no different. You will find yourself in a situation where you say, “We need someone yesterday.” This leads to a rushed hiring process, which can lead to:
“Our payroll can be upwards of 25, 30, 40% of all of our expenses, and so we like to plan accordingly for that,” said Conger.
“Knowing who you're going to need ahead of time will allow you the appropriate amount of time to find and hire that person, rather than be reactive if somebody leaves, or reactive when you desperately need someone. All of a sudden you say, ‘I gotta hire somebody in the next 2 weeks.’ We want to avoid that.”
Let’s go back to our example from the first section. Let’s say that’s you. You are the practice’s manager, marketing expert, administrative support, receptionist, and salesman. Exhausted and overwhelmed, you set out to hire a well-rounded person with a can-do attitude to wear some of your hats.
“You've got a solo practitioner who's operating everything on their own and they're like, ‘I'm so busy, I've got to hire somebody.’ And so what they do is that they end up looking for that one person who could somehow fill every needed responsibility on the org chart for them,” explained Botts.
“I'm looking for a certified health coach who is also going to be my front-desk receptionist, and is also going to handle my online marketing… If you hire a health coach and ask them to sit at the front desk answering phones, then you're overpaying someone to fill that role.”
Let’s say your certified health coach earns $100,000 per year, which equates to about $52.00 an hour. They’re making $52.00 per hour when they’re with clients and making your practice money (good!), but they’re also making $52.00 for every hour they’re simply answering phone calls (very bad!).
In your search for someone who can take all these tasks off your plate, you hire someone who appears to be good at just about everything. That mentality seems sound, but it can lead to problems.
“I call that hiring generalists or Jacks-of-all-trades. The problem with that is as the business grows, these roles become specialized. With a Jack-of-all-trades, the end of that phrase is master of none,” said Conger.
“And then you get a really great person who is very good at a number of different jobs, but not great at any one of them. And then you have a really tough decision to make when it comes time to scale.”
You need specialists, not generalists.
By hiring this Jack-of-all-trades, you may be creating a literally irreplaceable employee. Their shoes are unfillable because knowledge transfer is impossible. So much of your day-to-day operations exist solely inside that person’s head or laptop, with systems/procedures that may only make sense to that person.
“What happens when they leave?” asked Conger.
“They're wearing 6 different hats and they leave. You have to find another person who can wear 6 different hats or you have to hire 4 to 5 different people.”
Now that you understand the hiring mistakes that hurt most cash-pay practices, you’re ready to go through an exercise that will help you avoid them.
Freedom Practice Coaching’s process can help you:
Here are the steps you need to follow.
The first thing you need is an organizational flow chart that shows where your practice is right now. You may have one already, or you may need to create one.
“Even if you just have 3 people, which is you and 2 other individuals, it's nice to have an example of what your org chart is,” said Conger.
For the purposes of this exercise, you can draw it out using a whiteboard or pen/ paper. However, you might want to use a digital template from Miro, Figma, Canva, Visio, or LucidChart, because you’re going to have to move things around during this exercise. This template provided by Freedom Practice Coaching is perfect.
Next, set a 12-month goal that you want to work towards. This is typically revenue-related. For example, you may want to work toward:
“If say, you're doubling in revenue, you may not need to double the size of your team,” said Conger.
Now you’re going to create a new org chart for the team that will take you to your goal.
You may need another practitioner, or an office manager, or even a wellness expert. However, Conger stresses that the crucial part of this step is adding job roles without people’s names.
“The critical piece of this is, I want you to put the roles, not the people. Do not translate the names of who you currently have over to these new roles. These are just roles, office manager, wellness assistant, mid-level practitioner. Not Jenny, Bob, or Sue,” said Conger.
“And that's really critical and important. What are those roles that you need to support your sustainable business at your future goal?”
Now add 3-5 key responsibilities for each role, while being careful not to assign too many “hats” or responsibilities for each role. Focus on specialization, not generalization, so there’s minimal overlap.
Now you’re going to slot your current team into the roles that each person can (honestly) fill.
Once this is completed, you will probably have a few roles you’re going to have to hire, as well as current staffers who don’t have a role in the new org.
And that’s okay. The point of this exercise is to identify these gaps. Next, create 2 columns off to the side of your new org chart, and place people/roles in each respective column.
Now, ask yourself if you can move someone from one side to the other. Will it require further training or support? Can you afford to help an existing staffer upskill themselves to be a better fit for your future plans?
Let’s create a hiring plan that doesn’t include surprises or rushed emergency-hires.
Click here to download a spreadsheet that will help you plan each one of the hires and transitions that you need to make, based on milestones that lead you towards your goal.
“So if your goal is doubling revenue, we may say 25% increase, then 50% increase, then 75% increase, each of them triggering a new hire in the logical path to get you to that place,” said Conger.
You may not be able to manage this process by yourself. If you’re looking to take your practice to the next level, we highly recommend reaching out to the team at Freedom Practice Coaching by clicking here.
We provide a do-it-all EHR, practice management and patient portal solution that helps you slash the time spent on administrative tasks, freeing up your time to work ON your business instead of being trapped by tasks IN your business.
“While it takes a while to customize Cerbo to fit your practice, it is well worth the investment and ultimately saves time and money. The best part is that this translates into successful patient outcomes while minimizing the burden of charting, educating, and day-to-day administrative tasks on the practice team.”
— Dr. Kristann Heinz, MD, RD, Red Hill Medical + Wellness, Pennsylvania.
Want to see what we can do for you? Click here to book a personalized demo!
